Healthcare Provider Details

I. General information

NPI: 1225627714
Provider Name (Legal Business Name): DANA MOSLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANA O'SHALL

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 WESTLINKS DR STE 103
FORT MYERS FL
33913-8001
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-5050
  • Fax: 239-343-4241
Mailing address:
  • Phone: 395-615-0502
  • Fax: 239-343-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: